Provider Demographics
NPI:1790070761
Name:WITTER, CHRISTIAN GUY (PT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:GUY
Last Name:WITTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 HWY 81 S
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3918
Mailing Address - Country:US
Mailing Address - Phone:770-554-0665
Mailing Address - Fax:770-554-0685
Practice Address - Street 1:313 NEFF AVE
Practice Address - Street 2:STE C
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3495
Practice Address - Country:US
Practice Address - Phone:540-434-1200
Practice Address - Fax:540-434-1203
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist